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J CNOTIFICATION OF HAZAARDOUSS WASTE DISCHARG L E 0 <br /> HEALTH & SAFETY CODE 25180.7 <br /> A. EMERGENCY LEVEI I III PHS-EH LOG# O 1 —OCA a-- <br /> irele one) <br /> B. SOURCE OF INFORMATION <br /> Name: Dan Mr—I I Ym,A Phone: (V� y&2--510 7 <br /> Company: K+K0 M <br /> Address: V Df l Ll5 D•D 1 DO Phone: ?,D� <br /> Designated Employee Name: I btu n �� <br /> Reporting Agency Name: SJ-C - - ✓ <br /> S i <br /> Address: 3 S� <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: Citv r County) Circle one <br /> (Best Physical Description) <br /> Date of Discharge: J Time: <br /> Date Notified: J64WO _�%_NZOOL <br /> D. RESPONSIBLE PERSONIBUSINESS <br /> Name of Business: 1 bn P <br /> 5707 <br /> Contact Person: Penn A�CT honey/ -�(�2' <br /> Phvsical Address: ) ✓ V S C <br /> Mailing Address: f. D. Q <br /> E. DESCRIPTION <br /> Type of Discharge: <br /> Volume: 3Q—Li6 � <br /> Chemicals: <br /> Circumstan es: <br /> F. ACTION TAKEN <br /> oz 5 <br /> SITE DISPOSITION Ilk )A <br /> EH 22 013 (Rev. 08/20/98) <br />